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Ulrich Museum of Art

Ulrich Art Loan Program Form

Name:

First Last

Job Title:

Campus Department:

Campus Phone:

Campus Email:

Campus address where work will be displayed:

Campus Building Room No.

Is the space locked when not in use?

Yes

No

Is the space in direct sunlight?

Yes

No

Brief comments describing the space where the art will be displayed:

Are there any features to the space that could potentially emit moisture or heat, and what is their proximity to the displayed art?

Artwork Request #1:

Artist

Name

Title

Accession No.

Artwork Request #2

Artist

Name

Title

Accession No.

Artwork Request #3

Artist

Name

Title

Accession No.

Artwork Request #4

Artist

Name

Title

Accession No.

Artwork Request #5

Artist

Name

Title

Accession No.

Artwork Request #6

Artist

Name

Title

Accession No.